Endoscopic organ retraction system and method of using the same

ABSTRACT

The present disclosure relates to a retraction system for retracting body organs and/or body tissue in a body cavity. The retraction system includes an elongate shaft configured and dimensioned to be inserted into the body cavity, a retractor device operatively associated with the elongate shaft, the retractor device having a first configuration for insertion into the body cavity and at least a second configuration for retraction of the body organ, and at least one anchor member operatively coupled to the retractor device for anchoring the retractor device to a wall of the body cavity.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a National Stage Application of PCT/US 03/15885 under 35 USC§371(a), which claims priority of U.S. Provisional Patent ApplicationSer. No. 60/381,721 filed May 17, 2002, the entire contents of which arehereby incorporated by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to devices, systems and methods used forretracting organs and/or body tissue during surgical procedures and,more particularly, to endoscopic or laparoscopic apparatus, systems andmethods for retracting or positioning body tissue and/or body organsduring minimally invasive surgery.

2. Background of Related Art

As a result of the recent technological improvements in surgicalinstruments, surgical procedures, using minimally invasive techniques(e.g., endoscopic, laparoscopic, etc.), are routinely performed, whichsurgical procedures cause less trauma to the patient.

In endoscopic and laparoscopic surgical procedures, it is oftennecessary to provide instrumentation to move or manipulate tissue andorgans located in the area of operation. Generally, laparoscopicsurgical procedures involve the introduction of a gas, such as, carbondioxide, to insufflate a body cavity, e.g., the abdomen, to provide aworking area for the surgeon. After the abdomen is insufflated, a trocardevice is utilized to puncture the peritoneum to provide an access portby way of a cannula through the abdominal wall for the introduction ofsurgical instrumentation. Generally, a trocar/cannula is placed throughthe abdominal wall for each piece of surgical instrumentation which isnecessary to carry out the surgical procedure. In this manner, thesurgeon may view the surgical site through an endoscope provided througha first trocar/cannula, and utilize a second trocar/cannula to introducea surgical instrument such as a grasper, scissor, clip applier, staplerand any other surgical instrument which may be necessary during theparticular surgical procedure.

Although the insufflation gas expands the abdomen to permit the surgeonto view the surgical site, it is often necessary to manipulate theinternal organs or tissues to provide a clear path to the surgicalobjective. In the past, grasping tools have been utilized which pull onthe organs or tissues to move them out of the way to provide a clearvisual path for the surgeon. Endoscopic retractor mechanisms also havebeen developed which are utilized to push and hold the tissue or organsaway from the surgical site. Typically, these devices include paddlesand/or fingers which expand after the retractor has been inserted intothe abdomen through the trocar cannula. Such devices are disclosed in,for example, U.S. Pat. No. 4,654,028 to Suma, U.S. Pat. No. 4,909,789 toTaguchi et al., and U.S. Pat. No. 5,195,505 to Josefsen. Other retractordevices include collapsible fingers joined by webs of resilient materialwhich expand to form the retractor. These devices are disclosed in, forexample, U.S. Pat. No. 4,190,042 to Sinnreich and U.S. Pat. No.4,744,363 to Hasson. Other devices include retractors having expandableframes for supporting expandable latex sheaths or covers, such as thosedescribed in U.S. Pat. No. 5,178,133 to Pena

Current endoscopic retractors are typically based on a 10 mm instrumentdiameter platform. Accordingly, some minimally invasive surgicalprocedures have limitations due to the small internal diameter of manycommonly used cannulas of trocar systems. However, as with mostendoscopic instruments, if possible, a smaller diameter retractiondevice is preferred in order to reduce the amount of trauma to thepatient. For example, many surgical procedures now utilize surgicaldevices based on a 5 mm instrument diameter platform. However, whenusing smaller diameter retraction devices, the amount of deflection atthe distal end of the smaller diameter retraction device is relativelygreater than the amount of deflection at the distal end of a largerdiameter retraction device. This increased deflection is undesirablewhen attempting to retract body organs since the smaller diameterretraction device will have difficulty in clearing the surgical field toprovide access for the surgeon to the surgical site.

Accordingly, a need exists for an endoscopic organ retraction systemhaving sufficient strength and durability to retract body organs fromthe operative site and, more particularly, to an endoscopic organretraction system which is relatively small and may be utilized withsmaller conventional trocar cannulas to provide access to the siteduring an endoscopic or laparoscopic surgical procedure.

The device disclosed herein overcomes the disadvantages associated withthe prior art and provides a light weight endoscopic retractor whichallows the surgeon to manipulate body organs and other body tissue.

SUMMARY

The presently disclosed retraction system overcomes many of thedisadvantages of prior art retractors by providing a retractor devicewhich increases the control over sections thereof, such as, for example,the distal end of the retractor device, as well as providing greaterretractive strength as compared to other retractor devices. In additionto providing greater retractive strength, the presently disclosedretractor system is particularly useful in connection with smallerdiameter surgical instrument platforms, such as, for example, 5 mmdiameter instrument platforms.

A retraction system includes a shaft configured and dimensioned to beinserted into a body cavity, a retractor device operatively associatedwith the shaft, the retractor device having a first configuration forinsertion into the body cavity and at least a second configuration forretraction of the body organ, and at least one securement memberoperatively coupled to the retractor device for securing the retractordevice to a wall of the body cavity.

The at least one securement member includes at least one sutureoperatively coupled to the retractor device. The at least one securementmember can include a plurality of sutures operatively coupled to theretractor device. The retraction system can further include a pluralityof anchors operatively couplable to the at least one suture, whereineach anchor is configured and adapted to anchor the sutures with respectto the wall of the body cavity. The at least one suture extends throughthe shaft.

In one embodiment, the retractor device includes a pair of resilientbands having distal ends operatively connected to one another, the bandsbeing movable between an open position forming a retracting surface anda closed position. The retractor device can be selectively removablyassociated with the shaft. The shaft desirably defines a lumen and theretractor device can be positioned within the lumen when the retractordevice is in the closed position. Desirably, the retractor deviceincludes a sheath surrounding the resilient bands. At least onesecurement member can extend from each of a distal end and a proximalend of the retractor device.

In another embodiment, the retractor device is a sling having a pair ofopposed ends. The at least one securement member includes at least onesuture extending from the sling. The shaft desirably defines a lumensuch that the sling can be positioned within the lumen.

According to another embodiment, the retractor device can be operativelyconnected to the shaft at a distal end of the elongate shaft, preferablyto a location along a length of the shaft. The at least one securementmember can be a suction device operatively connected to a distal end ofthe securement shaft. The suction device is desirably configured andadapted to transmit a vacuum effect to the wall of the body cavity. Theretraction system further includes a source of vacuum operativelyconnected to the suction device. The retractor device includes aplurality of blade members movable to a fanned-out position.

The present disclosure is also directed to a method of retracting. Themethod includes the step of inserting a retraction system having aretraction device and a securement member into a body cavity through aninsertion point on a first side of the body cavity when the retractiondevice in the first configuration. The insertion point is preferablylocated at a position which is spaced a longitudinal distance from atransverse plane defined by a body organ and/or tissue to be retracted.

The method further includes the steps of securing the at least onesecurement member to a wall of the body cavity opposite the first side,the at least one securement member being secured to the wall at aposition spaced a longitudinal distance from the transverse plane, andurging the retractor device against the body organ and/or tissue so asto displace the body organ and/or tissue in the longitudinal direction.

It is envisioned that the securement member is a suture having a firstend extending from a distal end of the retractor device, the methodfurther comprising advancing the suture to the wall of the body cavityopposite the first side. The suture includes a second end extendingthrough a shaft, and the step of urging includes tensioning the suture.

It is contemplated that the retractor device includes a pair ofresilient bands, the bands being movable between an open positionforming a retracting surface and a closed position, and the methodincludes deploying the retractor device to the open position.

It is envisioned that the retraction system has a shaft which isremovable from the suture and the retractor device. Accordingly, themethod includes the step of removing the shaft.

The retraction system desirably includes a shaft defining a lumen.Accordingly, the method includes deploying the retractor device byreleasing the retractor device from the lumen.

It is envisioned that the retractor device includes a sheath surroundingthe resilient bands. The shaft can be withdrawn after the at least onesecurement member is secured to the wall. It is further envisioned thatthe retractor device is a sling having a pair of opposed ends, and themethod includes disposing the sling around the body organ and/or bodytissue.

Desirably, the at least one anchor member includes at least one sutureextending from each opposed end of the sling, and the step of urgingincludes manipulating the at least one suture.

It is envisioned that the at least one securement member is a suctiondevice operatively connected to a distal end of a shaft. As such, themethod of securing includes the step of activating the suction device.

The retraction device includes a plurality of blade members.Accordingly, the method includes deploying the blade members to afanned-out position.

The presently disclosed retraction systems and methods, together withattendant advantages, will be best understood by reference to thefollowing detailed description in conjunction with the figures below.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the presentdisclosure and, together with the detailed description of theembodiments given below, serve to explain the principles of thedisclosure.

FIG. 1 is a schematic illustration of a method of using a retractionsystem, in accordance with an embodiment of the present disclosure;

FIG. 2 is a schematic illustration of a method in accordance with theembodiment of FIG. 1, at a later stage in the method;

FIG. 3 is a schematic illustration of a method in accordance with theembodiment of FIGS. 1–2, at a later stage in the method;

FIG. 3A is a schematic illustration of the retraction system of FIGS.1–2 depicting an alternative method of using the retraction system; FIG.4 is a schematic illustration of a method in accordance with theembodiment of FIGS. 1–3, at a later stage in the method; FIG. 5 is aschematic illustration of a method in accordance with the embodiment ofFIGS. 1–3 and 4, at a later stage in the method;

FIG. 6A is an enlarged perspective view of a retractor device, shown ina first configuration, according to an alternative embodiment of thepresent disclosure;

FIG. 6B is an enlarged perspective view of the retractor device of FIG.6A shown in a second configuration;

FIG. 7A is a schematic illustration of a method of using a retractionsystem, in accordance with another embodiment of the present disclosure;

FIG. 7B is a schematic illustration of a method of using a retractionsystem in accordance with the embodiment of FIG. 7A at a later stage inthe method;

FIG. 7C is a schematic illustration of a method in accordance with theembodiment of FIGS. 7A–7B, at a later stage in the method;

FIG. 8 is a schematic illustration of a method of using a retractionsystem, in accordance with another embodiment of the present disclosure;

FIG. 9 is a schematic illustration of a method in accordance with theembodiment of FIG. 8, at a later stage in the method;

FIG. 10 is a schematic illustration of a method in accordance with theembodiment of FIGS. 8–9, at a later stage in the method;

FIG. 11 is a schematic illustration of a method in accordance with theembodiment of FIGS. 8–10, at a later stage in the method;

FIG. 12 is a schematic illustration of a method in accordance with theembodiment of FIGS. 8–11, at a later stage in the method;

FIG. 13 is a schematic illustration of a method in accordance with yetanother embodiment of the present disclosure;

FIG. 14 is a schematic illustration of a method in accordance with theembodiment of FIG. 13, at a later stage in the method; and

FIG. 15 is an enlarged detail view of the distal end of the retractionsystem in accordance with the embodiment of FIGS. 13 and 14.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring initially to FIGS. 1–5, an illustrative example of anendoscopic retraction system, in accordance with the present disclosure,is shown generally as retraction system 100 which includes an elongateshaft 102 extending distally from a handle portion 104. Elongate shaft102 and handle 104 include a lumen (not shown) extending completelytherethrough. Retraction system 100 further includes a retractor device106 operatively connected to a distal end 108 of shaft 102. While it ispreferred that retractor device 106 is positioned at distal end 108 ofshaft 102, it is envisioned that retractor device 106 can be disposedand/or located at any location along shaft 102, between handle portion104 and distal end 108.

Retractor device 106 is deployable from a first configuration, e.g.,closed configuration (see FIGS. 1 and 2), for insertion of retractionsystem 100 into an abdominal cavity “AC” through an abdominal wall “W1”and/or removal of retraction system 100 through abdominal wall “W1”, toa second configuration, e.g., partially or fully opened configuration(see FIGS. 3, 4 and 5), for retraction of body tissue, including aninternal body organ “O” (e.g., a liver). Manipulation of retractordevice 106 from the first to the second configuration and back again canbe accomplished manually or automatically by operatively coupling anexpansion mechanism to handle portion 104 for remote deployment.

An example of a retractor device or paddle including deploymentmechanism may be found in commonly assigned U.S. Pat. No. 5,656,012 toSienkiewicz, the disclosure of which is hereby incorporated by referenceherein. Briefly, Sienkiewicz discloses in certain embodiments thereof asurgical retractor having a handle portion, an elongated body portionextending distally from the handle portion and including an outer tube,a fixed stabilizing member extending from a distal end of the outer tubeand a pair of resilient bands pivotally connected to a distal endportion of the stabilizing member. An actuation mechanism is providedwhich is associated with the handle portion and proximal end portions ofthe bands for moving the bands between open and closed positions. Thesurgical retractor of Sienkiewicz further includes a sheath dimensionedto receive at least a portion of the stabilizing member and the bands.Accordingly, when the bands are deployed, the sheath is expanded so asto define a retracting surface for manipulating body tissue and organsduring a laparoscopic or endoscopic surgical procedure.

Alternatively, retractor device 106 may be formed as any other suitableexpandable retractor, such as, for example, multiple deployable blades.An example of such an expandable retractor including a deploymentmechanism is disclosed in commonly assigned U.S. Pat. No. 5,456,695 toHerve-Dallemange, the disclosure of which is hereby incorporated byreference herein. Briefly, Herve-Dallemange discloses, in certainembodiments thereof, a multi-tool surgical apparatus including a handleassembly and a body portion which extends from the handle assembly. Themulti-tool surgical instrument further includes a first tool meansoperatively associated with a distal end portion of the body portion forperforming a first surgical task, and second tool means operativelyassociated with a medial section of the body portion for performing asecond surgical task. Herve Dallemange discloses that the second toolmeans is a plurality of interleaved cooperating blade members which aremovable between an open position and a closed position for performingretraction tasks during a surgical procedure.

Any deployment mechanism may be used. For example, U.S. Pat. No.5,656,012 to Sienkiewicz, the disclosure of which is hereby incorporatedby reference herein, discloses in certain embodiments a deploymentmechanism comprising a rotatable knob operatively associated with acentral rod. The central rod is slidably disposed with respect to astabilizing member. Resilient bands have a proximal end attached to thecentral rod and a distal end attached to the stabilizing member.Rotation of the knob moves the central rod distally, expanding theresilient bands. The resilient bands form a surface for retractingtissue within the patient's body. The deployment mechanism disclosed incertain embodiments of U.S. Pat. No. 5,456,695 to Herve Dallemange mayalso be used. Blade members are deployed through interaction with adrive screw assembly. The blade members are engaged with a pin attachedto a drive bar. The drive bar moves in a distal direction to deploy theblade members to a fanned-out configuration. The drive bar is attachedto the drive screw assembly through a pin at a proximal end of the drivebar. The drive screw assembly has a threaded exterior surface forinteraction with the threaded interior surface of a rotatable knob. Thedrive screw assembly translates in a distal direction on a guide tube inresponse to rotation of the knob, causing distal movement of the drivebar and deployment of the blade member. In further embodiments, theretractor is self-deployable. The retractor comprises resilient membersbiased to an expanded position within a sleeve. The resilient membersmay comprise a material biased to the expanded position or a separatebiasing element, such as a spring, may be provided. In furtherembodiments, sutures may be used as a deployment mechanism. Desirably,the deployment mechanism deploys and collapses the retractor device. Thedeployment mechanism may be detachable from the retractor device.

Retractor device 106 may be of a variety of different types, forexample, paddle-forming expandable elongated elements, balloon, solidsurface, etc. and can be manufactured in a variety of fashions. Forexample, retraction system 100 can be completely disposable or include aremovable retractor device 106, which is disposable, and a reusablehandle portion 104.

In accordance with the present disclosure, retraction system 100 furtherincludes at east one control member, preferably a number of elongatedcontrol members. For illustrative purposes only, as shown in FIGS. 1–5,retraction system 100 includes three sutures “A, B and C” operativelyassociated with retractor device 106. However, it is envisioned that,depending on the particular surgical procedure, retraction system 100can include more or less sutures as desired and/or needed. As seen inFIGS. 3–5, sutures “A, B and C” are preferably attached to a distal endof retractor device 106, however, it is envisioned that sutures “A, Band C” can extend from any location along the outer surface of retractordevice 106 depending upon the desired manipulation required ofretraction system 100 desired. In one preferred embodiment, it isenvisioned that each suture “A, B and C” is provided with a needle 112(FIGS. 1–3) at a distal end thereof.

It is envisioned that, depending on the particular surgical procedure,that retraction system 100 will include more or less sutures as needed.It is further envisioned that sutures “A, B and C” are adapted to besecured to an opposed abdominal wall “W2”. In one method, as seen inFIG. 3, a grasping tool 150 is provided for pushing the individualsutures “A, B and C” through abdominal cavity “AC”. Preferably, graspingtool 150 includes an elongate shaft 152 having a jaw mechanism 154operatively coupled to a distal end thereof and a trigger mechanism 156operatively coupled to a proximal end thereof for manipulating jawmechanism 154. In use, grasping tool 150 is used to enter abdominalcavity “AC” through an abdominal wall “W1”, on the same side from whichretraction system 100 is inserted into abdominal cavity “AC”, grasps aneedle 112 of one of sutures “A, B and C” and extends and/or pushesneedle 112 and suture “A, B or C” across abdominal cavity “AC” to securesuture “A, B or C” to opposite abdominal wall “W2”. This step isrepeated for each suture “A, B and C”.

Alternatively, as seen in FIG. 3A, it is envisioned that grasping tool150 can be used to enter abdominal cavity “AC” through abdominal wall“W2”, on a side opposite abdominal wall “W1” from which retractionsystem 100 enters abdominal cavity “AC”, grasps a needle 112 of one ofsutures “A, B and C” and pulls and/or withdraws needle 112 and suture“A, B or C” across abdominal cavity “AC” to secure suture “A, B or C” toabdominal wall “W2”.

If no needles 112 are provided on the distal ends of sutures “A, B andC”, sutures “A, B and C” can be pulled through abdominal wall “W2” usingan endoscopic grasping or suturing device such as, for example, anENDO-CLOSE™ instrument available from United States Surgical, a divisionof Tyco Healthcare Group LP, Norwalk, Conn. Reference can be made tocommonly assigned U.S. Pat. No. 5,281,237, the disclosure of which ishereby incorporated by reference herein, for a detailed description ofan exemplary ENDO-CLOSE™ instrument.

As shown in FIGS. 3 and 3A, it is contemplated that retraction system100 can be provided with a plurality of anchors 110 which can becoupled, one each, to a respective distal end of sutures “A, B and C”after sutures “A, B and/or C” are passed through abdominal wall “W2”. Inparticular, in accordance with the present disclosure, once a suture “A,B or C” is pulled out of abdominal cavity “AC”, through abdominal wall“W2”, an anchor 110 is coupled to the end of each suture “A, B or C” inorder to prevent the suture “A, B or C” from being pulled back intoabdominal cavity “AC”. Preferably, anchors 110 are positioned in contactwith the outer surface of abdominal wall “W2” in order to maintainsutures “A, B or C” in tension. In this manner, sutures “A, B and C” areessentially anchored to abdominal wall “W2”. As understood and usedherein, anchors 110 include, but are not limited to, clamps, clips,staples, rods, knots and the like. Anchors 110 may comprise any devicefor securing the sutures to the abdominal wall, including devices thatattach to or otherwise engage the abdominal wall.

In one embodiment, it is envisioned that the proximal ends of sutures“A, B and C” pass through retractor device 106 and through the lumen ofshaft 102 and handle 104 in order to exit abdominal cavity “AC” throughabdominal wall “W1”. In this manner, after sutures “A, B and C” havebeen anchored to abdominal wall “W2”, retractor device 106 and elongateshaft 102 can be slid into position, along sutures “A, B and C”.Accordingly, as seen in FIG. 5, handle 104 and shaft 102, if desired,can be withdrawn from abdominal cavity “AC” and the proximal ends ofsutures “A, B and C” can be stitched to abdominal wall “W2” or at leastanchored to abdominal wall “W2” by a anchor 110 to thereby securesutures “A, B and C” in place.

With continuing reference to FIGS. 1–5, a preferred method of usingretraction system 100 will now be described. In use, retraction system100 is configured and adapted to retract a body organ “O” in a direction“α” (FIGS. 4 and 5) in order to provide a surgeon with an enlarged spaceand increased room to operate. Accordingly, retractor device 106 ofretraction system 100 is inserted into abdominal cavity “AC” through aninsertion point “P” formed in abdominal wall “W1”, at a location in adirection “α” relative to a plane extending through body organ “O” andoriented transversely to direction “α”. Retraction system 100 isadvanced toward body organ “O” such that a distal end of shaft 102 is inclose proximity to body organ “O”. In other words, insertion point “P”of retraction system 100 is preferably at a location which is spaced alongitudinal distance (e.g., in the direction opposite “α”) from thetransverse plane. It is envisioned and within the scope of the presentdisclosure to have a trocar system (not shown) operatively disposed atinsertion point “P” which in turn provides access to abdominal cavity“AC” through abdominal wall “W1”. Desirably, abdominal cavity “AC” isinsufflated and the trocar system or other port is arranged to maintaininsufflation.

Sutures “A, B and C” are then secured to or pulled through oppositeabdominal wall “W2” using known surgical techniques or by using a methodas described above. Preferably, sutures “A, B and C” are pulled throughabdominal wall “W2” at locations spaced a longitudinal distance, in thedirection “α”, from the transverse plane extending through body organ“O”.

Retractor device 106 is then deployed (i.e., manipulated from the firstconfiguration to the second configuration) in order to increase thesurface area against which body organ “O” contacts. With retractordevice 106 deployed to the second configuration and in position, anchors110 can be coupled to sutures “A, B and C” at a location adjacent theexterior surface of abdominal wall “W2” or sutures “A, B and C” can beotherwise secured to abdominal wall “W2” in order to prevent sutures “A,B and C” from slipping or being withdrawn back into abdominal cavity“AC”. Sutures “A, B and C” are then tensioned by withdrawing and/orpulling on the proximal ends of sutures “A, B and C” (i.e., the portionof sutures “A, B and C” extending out of abdominal cavity “AC” throughabdominal wall “W1”). Tensioning of sutures “A, B and C” causesretractor device 106, as well as body organ “O”, to be moved and/orurged in direction “α”. The proximal end of shaft 102 may be securedexternally or may be secured to abdominal wall “W1”. In accordance withthe present disclosure, sutures “A, B and C” effectively provide supportto the distal end of shaft 102 by being secured to abdominal wall “W2”.Accordingly, the tendency of the distal end of shaft 102 to deflectduring retraction of body organ “O” will be reduced as compared to anorgan retractor having an unsupported distal end. An external supportmay be connected to sutures A, B and C and/or connected to the proximalend of the shaft 102 and handle 104.

Preferably, as described above, insertion point “P” for retractionsystem 100 through abdominal wall “W1”, and the points in abdominal wall“W2” through and/or to which sutures “A, B and C” pass and/or aresecured to are selected such that when sutures “A, B and C” aretensioned, retractor device 106 as well as body organ “O” will moveand/or be urged in direction “α”.

Following the surgical procedure, the tension on sutures “A, B and C”can be removed thereby allowing body organ “O” to return substantiallyto its original position in abdominal cavity “AC”. Sutures “A, B and C”are then released from abdominal wall “W2” and retractor device 106manipulated to the first configuration so that retraction system 100 canbe withdrawn from abdominal cavity “AC”.

It is envisioned that elongate shaft 102 can be provided with a lockingmechanism (not shown) for selectively fixing the position of sutures “A,B and C” extending through the lumen thereof. In certain embodiments, asdiscussed above, shaft 102 and handle 104 are detached and removed andthe sutures are secured to insertion point “P”.

Turning now to FIGS. 6A and 6B, a retraction system in accordance withanother embodiment of the present disclosure is shown generally as 160.It is envisioned that retraction system 160 includes a refractor device161 which operates in combination with an elongate insertion tube 170(shown in phantom in FIG. 6A) defining a lumen 172 therethrough. It isenvisioned that retractor device 161 is slidingly receivable in lumen172 of insertion tube 170.

As seen in FIGS. 6A and 6B, retractor device 161 is deployable from afirst configuration, e.g., closed configuration (see FIG. 6A), duringpassage of insertion tube 170 into abdominal cavity “AC” throughabdominal wall “W1” and/or removal of retractor device 161 fromabdominal cavity “AC”, to a second configuration, e.g., partially orfully opened configuration (see FIG. 6B), during retraction of aninternal body organ “O” (e.g., a liver). Deployment of retractor device161 from the first to the second configuration is preferablyaccomplished automatically as will be described in greater detail below.

Desirably, as seen in FIGS. 6A and 6B, retractor device 161 includes apair of resilient band members 161 a, 161 b fixedly secured to oneanother at proximal ends 162 a, 162 b, respectively, and at distal ends163 a, 163 b, respectively. Resilient bands 161 a, 161 b are preferablyformed of stainless steel or other flexible material, such as shapememory alloy or a flexible polymer, the configuration of which can becontrolled mechanically by applying a stress thereto. In the presentembodiment, resilient bands 161 a, 161 b are movable between the secondconfiguration (i.e., open or deployed configuration) and the firstconfiguration (i.e., closed or retracted configuration). In the secondconfiguration each resilient band 161 a, 161 b preferably has an arcuateconfiguration while in the first configuration each resilient band 161a, 161 b is substantially planar and/or linear. Each resilient band 161a, 161 b is preferably fabricated to have a rectangular cross-sectionalprofile to thereby strengthen each band 161 a, 161 b. Alternatively,each band 161 a, 161 b can have a semi-circular cross-sectional profileor any other suitable cross-sectional profile.

Retractor device 161 further includes an expandable sheath 166preferably configured and dimensioned to substantially surroundresilient bands 161 a, 161 b. Alternatively, it is envisioned thatsheath 166 can be secured to each of the juxtaposed surfaces ofresilient bands 161 a, 161 b. Expandable sheath 166 is preferablyfabricated from a textile material such as surgical mesh, cloth, nylon,etc. Alternatively, sheath 166 can be fabricated from an elastomericmaterial such as, for example, latex. Accordingly, when retractor device106 is in the second configuration, sheath 166 is expanded (i.e.,stretched out over resilient bands 161 a, 161 b so as to define aretracting surface 167 for manipulating body tissue and organs duringlaparoscopic and/or endoscopic surgical procedures.

In accordance with the present disclosure, retractor device 161 furtherincludes a 15 first set of sutures “A₁, B₁ and C₁” attached to a distalend thereof and a second set of sutures “A₂, B₂ and C₂” attached to aproximal end thereof. It is envisioned and understood that sutures “A, Band C” may extend from retractor device 161 at any location along theouter surface thereof depending upon the desired manipulation requiredand/or desired a given surgical procedure.

It is envisioned that the same sutures “A, B and C” can extend throughretractor device 161 and extend from both the distal end and theproximal end. It is further envisioned that retractor device 161 can beslidable along the length of sutures “A, B and C”.

Sutures “A₁, B₁ and C₁” can be pulled or pushed through abdominal wall“W2” using an endoscopic grasping or suturing device, such as, forexample, the ENDO-CLOSE™ instrument as described above. It iscontemplated that a plurality of stops or anchors 110 can be providedwhich can be coupled, at least one each, to a distal end of each suture“A₁, B₁ and C₁” after sutures “A₁, B₁, and/or C₁” have been passedthrough abdominal wall “W2”.

In use, as seen in FIGS. 7A–7C, retractor device 161 is in the firstposition and slidably disposed in lumen 172 of insertion tube 170.Desirably, abdominal cavity “AC” is insufflated and a trocar system orother port used to maintain insufflation. Preferably, sutures “A₁, B₁and C₁” extend out a distal end of insertion tube 170 and insertion tube170 is inserted, through insertion point “P” formed in abdominal wall“W1”, into abdominal cavity “AC” at a location with respect to adirection “α” relative to a plane extending through body organ “O” andoriented transversely to direction “α”. Sutures “A₁, B₁ and C₁” aresecured to abdominal wall “W2” in the same manner as sutures “A, B andC” of retraction system 100 described above. Preferably, as seen in FIG.7B, sutures “A₁, B₁ and C₁” are secured to abdominal wall “W2” anddesirably spaced in the direction “α” relative to the transverse plane.Desirably, sutures “A₁, B₁ and C₁” are secured to abdominal wall “W2”,with anchors 110, such that sutures “A₁, B₁ and C₁” have a length whichplaces the distal end of insertion tube 170 in close proximity to bodyorgan “O”.

Alternatively, it is envisioned that each suture “A₁, B₁ and C₁” isprovided with a needle 112 at a distal end thereof. In this manner,sutures “A₁, B₁ and C₁” can be secured to abdominal wall “W2” in thesame manner as described above with regard to retractor device 106.

As seen in FIG. 7B, with sutures “A₁, B₁ and C₁” anchored to abdominalwall “W2”, insertion tube 170 is withdrawn in a direction “X” therebycausing retractor device 161 to be pulled from insertion tube 170 anddeployed to the second configuration in the proximity of body organ “O”.In certain embodiments, as seen in FIG. 7C, insertion tube 170 iscompletely withdrawn from abdominal cavity “AC” such that sutures “A₂,B₂ and C₂” extend out of insertion point “P”. Sutures “A₂, B₂ and C₂”are then pulled and/or tensioned, in direction “X”, to thereby moveand/or urge body organ “O” in direction “α”. Sutures “A₂, B₂ and C₂” canthen be secured to abdominal wall “W1” in the same manner as sutures“A₁, B₁ and C₁” to hold body organ “O” in the retracted position. Incertain embodiments, sutures “A₁, B₁ and C₁” and/or “A₂, B₂ and C₂” areattached to an external support.

Following the surgical procedure, sutures “A₁, B₁ and C₁” are releasedfrom abdominal wall “W2” thereby allowing body organ to substantiallyreturn to its pre-retracted position. The insertion tube 170 may bere-introduced into abdominal cavity “AC”, through insertion point “P”.Sutures “A₂, B₂ and C₂” are fed through lumen 172 of insertion tube 170.With sutures “A₂, B₂ and C₂” in place in insertion tube 170, eitherinsertion tube 170 is distally advanced over sutures “A₂, B₂ and C₂” orsutures “A₂, B₂ and C₂” are proximally withdrawn through insertion tube170. In either manner, proximal ends 162 a, 162 b of resilient bands 161a, 161 b enter lumen 172 of insertion tube 170. The action is continueduntil resilient bands 161 a, 161 b are urged to the first position dueto a camming action between the distal end of insertion tube 170 andresilient bands 161 a, 161 b of retractor device 161. Insertion tube 170can then be fully withdrawn from abdominal cavity “AC” and the surgicalprocedure completed. In further embodiments, sutures “A₁, B₁ and C₁”and/or “A₂, B₂ and C₂”, or additional sutures are used to erge theresilient bands 161 a, 161 b to the first position.

Referring now to FIGS. 8–12, an alternative embodiment of a retractionsystem, in accordance with the present disclosure, is shown generally as200. Retraction system 200 includes a retractor 202 for retracting bodyorgan “O” and an insertion tool 220 for deploying retractor 202.Preferably, as seen in detail in FIGS. 11 and 12, retractor 202 is inthe form of a sling or hammock like structure. Insertion tool 220includes a hollow elongated shaft 222 and a handle portion 224operatively coupled to a proximal end of shaft 222. Preferably,insertion tool 220 defines a central lumen 221 extending completelythrough shaft 222 and handle 224. It is envisioned that central lumen221 of shaft 222 is configured and adapted to receive retractor 202therein. It is contemplated that shaft 222 can be straight, curvedand/or preferably fabricated from a material which is flexible and/orpliable to enable bending of a straight elongate shaft to a curvedelongate shaft.

Retractor 202 includes a sling section 204 having a first end 206 and asecond end 208 and at least one suture “A” extending between and fromends 206, 208 of sling section 204. The suture “A” may be attached toone or more ends of sling 204 and/or attached at one or more pointsbetween the ends. Separate sutures may extend from each of ends 206,208. As described above with regard to sutures “A, B and C” ofretraction system 100, suture “A” of retraction system 200 can be eitherpushed and/or pulled through abdominal wall “W” using known surgicaltechniques and instruments, such as, for example, an endoscopic suturinginstrument such as the ENDO-CLOSE™ instrument as described above.

It is envisioned that retraction system 200 preferably further includesat least one port 210, i.e., a trocar cannula, configured and adapted toprovide access into and out of abdominal cavity “AC” and through whichsuture “A” can pass and be anchored to. Preferably, port 210 creates anair tight seal around shaft 302 and in abdominal wall “W1” to therebyprevent the escape of insufflation gas from abdominal cavity “AC”.

Sling section 204 can be made from a medical grade mesh havingsufficient openings to enable access to retracted body organ “O” atvarious locations along the surface thereof. Preferably, sling section204 is fabricated from a textile material such as surgical mesh, cloth,nylon, etc. Alternatively, sling section 204 can be fabricated from anelastomeric material such as, for example, latex, polypropylene,polyethylene, etc.

With continued reference to FIGS. 8–12, a preferred method of use ofretraction system 200 will now be described. Desirably, abdominal cavity“AC” is insufflated and a trocar system or other port is used tomaintain insufflation. In use, retractor system 200 is configured andadapted to retract body organ “O” in direction “α” in order to provide asurgeon with an enlarged space and increased room to operate.Preferably, at least one pair of ports 210 is provided in opposedabdominal walls “W1, W2”. It is contemplated that ports 210 are placedat a location which is spaced a longitudinal distance, in direction “α”,from a plane defined by body organ “O”.

Shaft 222 of insertion tool 220, having retractor 202 disposedtherewithin, is inserted into the abdominal cavity through port 210disposed in abdominal wall “W1”. In accordance with the presentdisclosure, retractor 202 is disposed within central lumen 221 of shaft222 such that one end of suture “A” extends from central lumen 221 andout the proximal end of handle 224 and the other end of suture “A”extends from central lumen 221 and out the distal end of shaft 222.Insertion tool 220 is then advanced through the abdominal cavity untilthe distal end exits abdominal cavity “AC” through port 210 provided inabdominal wall “W2”, as seen in FIG. 8. Preferably, shaft 222 issufficiently bent and deformed in order to pass around/below body organ“O”. The distal end of suture “A” is then withheld as insertion tool 220is withdrawn back through abdominal cavity “AC”. In so doing, as seen inFIG. 9, as shaft 222 is withdrawn, retractor 202 is essentially pulledfrom within central lumen 221 of shaft 222. Preferably, insertion tool220 is withdrawn until shaft 222 is completely pulled from the abdominalcavity, as seen in FIG. 10.

As seen in FIG. 11, sling section 204 of retractor 202 is then openedand placed over and around body organ “O”. With sling section 204 inplace, pulling on either end of suture “A”, places sling section 204 andsuture “A” in tension, thereby retracting body organ “O” in direction“α”.

Preferably, as described above, ports 210 are positioned at locations onabdominal walls “W1, W2” such that tensioning of suture “A”, which inturn tensions sling section 204, results in the movement and retractionof body organ “O” in direction “α”. Similar to retraction system 100described above, retraction system 200 can further include an anchor 212coupled to each end of the suture “A” or sutures adjacent the outersurface of abdominal walls “W1, W2”. Thus, after the ends of suture “A”have been tensioned, anchors 212 are attached to sutures “A” in order tomaintain suture “A” in tension and in order to prevent suture “A” fromslipping back into the abdominal cavity. In accordance with the presentdisclosure, suture “A” provides support to ends 206, 208 of sling 204.An external support may be attached to the suture or sutures in certainembodiments. The sling-type retraction device may be used in theembodiments depicted in FIGS. 1–7C or FIGS. 13–15.

Removal of retractor 202 is accomplished by releasing either or bothends of suture “A” from abdominal walls “W1, W2” to thereby allow bodyorgan “O” to substantially return to its pre-retracted position inabdominal cavity “AC”. An end of suture “A” can then be pulled on tothereby withdraw retractor 202 from abdominal cavity “AC”.

Turning now to FIGS. 13–15, yet another embodiment of a retractionsystem in accordance with the present disclosure is shown generally as300. Retraction system 300 includes an elongate shaft 302 extendingdistally from a handle portion 304. Retraction system 300 furtherincludes a retractor device 306 preferably disposed at a predeterminedlocation along shaft 302, between handle portion 304 and distal end 308of shaft 302.

Retraction system 300 further includes an anchoring device 310operatively coupled to distal end 308 of shaft 302. As seen in FIGS.13–15, anchoring device 310 can be characterized as a suction device 312which is configured and adapted to be anchored to an inner surface ofabdominal wall “W2” via a vacuuming/suctioning effect transmittedthereto. It is contemplated that suction device 312 is fluidly coupledto a vacuum source 350 via a vacuum tube 314 which extends throughhandle 304 and shaft 302 in order to produce the vacuum/suction effectin suction device 312. Preferably, vacuum tube 314 includes a distal endin fluid communication with suction device 312 and a proximal end influid communication with vacuum source 350.

Preferably, retractor device 306, in accordance with the presentdisclosure, is similar in form and function to the retractor portiondisclosed in commonly assigned U.S. Pat. No. 5,456,695 to HerveDallemange, the disclosure of which is hereby incorporated by referenceherein. In particular, it is envisioned that retractor device 306includes a plurality of cooperating interleaved blade members 307pivotably mounted within a supporting yoke. Blades members 307 arepreferably configured and adapted to move between a first position(i.e., closed) wherein blade members 306 are in longitudinal alignmentwith shaft 302 and a second position (i.e., open) wherein blade members306 are disposed in a symmetric fan-like configuration, oriented in adistal and/or proximal direction.

It is envisioned that retraction system 300 preferably further includesat least one port 320, i.e., a trocar cannula, configured and adapted toprovide access into abdominal cavity “AC” and through which shaft 302can pass. Preferably, port 320 creates an air tight seal around shaft302 and in abdominal wall “W1” to thereby prevent the escape ofinsufflation gas from abdominal cavity “AC”.

With particular reference to FIGS. 13 and 14, a preferred method ofusing retraction system 300 will now be described. In use, retractionsystem 300 is configured and adapted to retract body organ “O” indirection “α” in order to provide the surgeon with an enlarged space andincreased room to operate. Accordingly, it is preferred that anchoringdevice 310 (i.e., suction device 312 herein) of retractor system 300 isinserted into the abdominal cavity, through insertion point “P” formedin abdominal wall “W1”, at a location which is spaced a longitudinaldistance, in direction “α”, from the plane defmed by body organ “O”.Retraction system 300 is then advanced through abdominal cavity “AC”, ina direction substantially opposite to direction “α”, until anchoringdevice 310 is advanced past body organ “O” and retraction portion 306 isin close proximity to body organ “O”.

Retractor portion 306 is then deployed from the closed position to theopen position in order to increase the surface area against which bodyorgan “O” contacts retractor portion 306. Shaft 302 is then rotated,about insertion point “P”, such that anchoring device 310 is moved indirection “α”. As shaft 302 is rotated to move anchoring device 310 indirection “α”, body organ “O” is moved in direction “α”. Once body organ“O” is sufficiently moved in direction “α” and sufficiently retracted,retraction system 300 is further advanced through abdominal cavity “AC”until anchoring device 310 is in operable proximity to abdominal wall“W2”.

With anchoring device 310 in operable proximity to abdominal wall “W2”,anchoring device 310 is activated in order to anchor and secure thedistal end of retraction system 300 against the inner surface ofabdominal wall “W2”. In particular, vacuum source 350 is activated totransmit a vacuum/suctioning effect to suction device 312 therebydrawing the inner surface of abdominal wall “W2” into suction device312. In accordance with the principles of the present disclosure,anchoring device 310 provides support to distal end 308 of shaft 302.External supports may be used at insertion point “P” and/or suctiondevice 312. Suction device 312 may be used in the embodiments shown inFIGS. 1–12 to anchor a proximal and/or distal end of the retractionsystem.

While the retraction system, in accordance with the present disclosure,has been described as being used in connection with surgical proceduresperformed in the abdominal cavity, it is envisioned that the retractionsystem disclosed herein can be used in various other surgicalprocedures. It is envisioned that any of the aspects and/or features ofretraction systems disclosed and described herein can be combined withone another to effectively provide a retraction system which issupported at both the proximal and distal ends. It will be understoodthat various modifications may be made to the embodiments of thepresently disclosed retraction system. Therefore, the above descriptionshould not be construed as limiting, but merely as an exemplification ofpreferred embodiments. Those skilled in the art will envision othermodifications within the scope of the present disclosure.

1. A retraction system, comprising: a shaft configured and dimensionedto be inserted into a body cavity; a retractor device selectivelypositionable within a lumen of the shaft, the retractor device includesa pair of resilient bands secured to one another at a first end and asecond end, and a sheath encasing the pair of resilient bands, theretractor device includes a biased first configuration, wherein the pairof resilient bands each have a substantially linear configuration andwherein the retractor device is positionable within the lumen of theshaft, and at least a second configuration, wherein the pair ofresilient bands each have an arcuate profile, for retraction of the bodyorgan, wherein the retractor device automatically assumes a secondconfiguration when withdrawn from the shaft; and at least one securementmember operatively coupled to the retractor device for securing theretractor device to a wall of the body cavity, wherein the at least onesecurement member includes a plurality of sutures operatively coupled toeach end of opposite ends of the retractor device.
 2. The retractionsystem of claim 1, further comprising: an anchor operatively couplableto each suture, wherein each anchor is configured and adapted to anchorthe sutures wit respect to the wall of the body cavity.
 3. Theretraction system of claim 1, wherein the retractor device is a slinghaving a pair of opposed ends.
 4. A retraction system, comprising: ashaft configured and dimensioned to be inserted into a body cavity; aretractor device selectively positionable within the shaft, wherein theretractor device is operatively connected to the shaft at a locationalong a length of the shaft and spaced a distance from a distal end ofthe shaft, wherein the retractor device has a first configuration inwhich the retractor device is housed within the shaft and a secondconfiguration in which the retractor device projects outwardly from theshaft; and at least one securement member operatively coupled to theretractor device for securing the retractor device to a wall of the bodycavity, wherein the at least one securement member is a suction deviceoperatively connected to a distal end of the shaft, the suction devicebeing configured and adapted to transmit a vacuum effect to the wall ofthe body cavity.
 5. The retraction system of claim 4, wherein theretractor device comprises a plurality of blade members movable to afanned-out position.
 6. A method of retracting, the method comprisingthe steps of: inserting a retraction system into the body cavity throughan insertion point on a first side of the body cavity, the insertionpoint being located at a position which is spaced a longitudinaldistance from a transverse plane defined by a body organ and/or tissueto be retracted, the retraction system including: a shaft configured anddimensioned to be inserted into a body cavity; a retractor deviceselectively positionable within a lumen of the shaft, the retractordevice includes a pair of resilient bands secured to one another at afirst end and a second end, and a sheath encasing the pair of resilientbands, the retractor device includes a biased first configuration,wherein the pair of resilient bands each have a substantially linearconfiguration and wherein the retractor device is positionable withinthe lumen of the shaft, and at least a second configuration, wherein thepair of resilient bands each have an arcuate profile, for retraction ofthe body organ, wherein the retractor device automatically assumes asecond configuration when withdrawn from the shaft; and at least onesecurement member operatively coupled to the retractor device forsecuring the retractor device to a wall of the body cavity; securing theat least one securement member to a wall of the body cavity opposite thefirst side, the at least one securement member being secured to the wallat a position spaced a longitudinal distance from the transverse plane;and urging the retractor device against the body organ and/or tissue soas to displace the body organ and/or tissue in the longitudinaldirection.